Prescription for rheumatoid arthritis

The course of rheumatoid arthritis (RA) is such that the inflammation created when the disease is active results in damage to the joints. The main aim of treating RA is to give medications which will suppress the inflammation. Effective treatment also aims to prevent joint destruction and the disability which results from this.

Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

Disease-Modifying Anti-Rheumatic Drugs (DMARDs) are sometimes also known as slow-acting anti-rheumatic drugs (SAARDs). They work by suppressing inflammation. It is important that treatment with DMARDs is started as soon as active RA is diagnosed, in order to help prevent joint deformity and disability. Because there are a number of potential side effects associated with taking DMARDs, the treatment should be closely monitored. Here are some of the DMARDs that are used in the treatment of RA.

Methotrexate (e.g. Ledertrexate, Methoblastin) is generally used in moderate to severe RA. Leflunomide (e.g. Arava), is used to treat severe active RA that does not respond to classical DMARDs such as methotrexate. Leflunomide is as effective as methotrexate in the treatment of RA.

Intramuscular gold injections of sodium aurothiomalate (e.g. Myocrisin), have a significant clinical benefit in the treatment of patients with RA. Plaquenil is often used in combination with other DMARDs.

Penicillamine (e.g. D-Penamine) is used in the treatment of moderate to severe RA. Cyclosporin shows clinical benefit in short-term treatment (up to one year) of people with progressive RA. A combination of methotrexate, hydroxychloroquine and sulfasalazine is more effective than methotrexate alone. Non-steroidal anti-inflammatory drugs (NSAIDs)

Non-steroidal anti-inflammatory drugs (NSAIDs) are often prescribed as pain killers. They also reduce inflammation in the treatment of inflammatory forms of arthritis, such as RA. Corticosteroids

Corticosteroids are used in the treatment of RA, both as tablets and as injections into the joint.

Prednisolone is sometimes used in moderate to severe RA where NSAIDs and DMARDs are not controlling the disease. Oral corticosteroids (those taken by mouth) are usually used at the lowest effective dose to minimise adverse effects such as weight gain, hypertension (high blood pressure) and osteoporosis.

Biologic agents

Recently, another category of arthritis treatments called tumour necrosis factor (TNF) inhibitors has been developed. It is found in high concentration in the joint fluid of people with RA. Infliximab (e.g. Remicade) is a TNF inhibitor available for the treatment of RA in selected patients.

Infliximab slows the progression of RA and reduces joint damage. Each treatment takes approximately 2 hours.

Infliximab is given in combination with methotrexate. Enbrel is used for the treatment of active, adult RA in people who have had an inadequate response to several DMARDs, including methotrexate.

In July 2003, Enbrel was listed on the Pharmaceutical Benefits Scheme (PBS) for selected patients with severe RA. Recently, a third anti-TNF medication, Humira (adalimumab), was added to the list of approved agents for RA. In studies, etanercept, infliximab and humira have shown substantial improvements in people with RA.